Military Suicide: A Former Army Psychiatrist’s Veterans Day Reflections

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The rates of suicide in the United States Army began to rise in 2004, and continued climbing until 2010. Then the suicide rate in the active duty finally started to level off, but continues to rise in National Guard soldiers. It remains twice as high as it was prior to the wars in Iraq and Afghanistan.

We have been at war for 10 years, with numerous deployments. However, my argument is that it is the unit’s deployment history —  rather than the individual deployment history — that contributes the most to suicide risk.

The issue is a high priority among Army and Department of Defense leaders. There has been a Department of the Army task force, a Defense Department task force, and an ongoing $50 million federal study into the challenges it poses. The first two of these contained several hundred recommendations.

What is well known are the risk factors for suicide in the military.  For the last 20 years, at least, the highest risk group is young, white and male. The precipitants also are well-known; relationship breakups and getting in trouble at work.

Service members who commit suicide do not have major psychiatric illness, in general. Instead, typically, there is a precipitating humiliating event.

About one-third of soldiers who suicides have never deployed.  Overall, one third suicide during deployment and one third afterward.

What is that about? In my prior life in the Army. I did numerous investigations of completed suicides. Over and over command told me, “This high optempo means I do not know my Soldiers.” There used to be all sorts of ways to incorporate a Soldier into a unit, picnics, runs, and barbeques. “Now we are all too busy.”

The installations with the highest suicide rate are those with the highest deployment optempo: Fort Campbell, Fort Carson, Fort Stewart, Fort Hood, and Fort Riley all come to mind.

A recently published article documents the data from the known suicides. It highlights the “stress load”; as well as the factors listed above. The “stress load is the accumulation of multiple stresses, including relationship break-ups, job difficulties, and physical problems.” (I was one of the authors.)

Another recently published excellent article, Reframing Suicide in the Military, is one of the few recent discussions of the relationship between society and suicide. It refers back to the ground-breaking works of Emile Durkheim and Joiner.

Durkheim,  in his classic study of suicides in France, describe “fatalistic suicides” as one category. Many Soldiers also develop a sense of fatalism when around frequent death and destruction.

Joiner emphasizes three factors as contributing to suicidal potential: (1) failed belongingness, (2) perceived burdensomeness and (3) habituation to self-injury. When looking at Army suicides, these three factors are pervasive, in one form or another.

For example, an emerging risk factor is the contribution of chronic pain and difficulty doing one’s job, due to a physical disability.  These seem to be the precipitants to the suicides of a number of older soldiers.

All Soldiers are at risk. Soldiers are a proud lot.  If they are humiliated, publicly or privately, and if that weapon is available, they may reach for it.

What is the solution? No silver bullets here. Suicide is a very complex problem as the Pentagon’s leadership has increasingly realized.

But for a start, we need to talk more about getting soldiers through the times when they are lost and humiliated and in pain.  We need to offer meaningful jobs. And focus on re-connecting Soldiers and their community.